The longer-standing function of accrediting nursing education organizations has been one of the NLN's chief reasons for being. The accreditation program covers all bases, accrediting programs for licensed practice nurses, diploma nurses, baccalaureate and master's level graduates. (There has been a power struggle for years concerning whether or not doctoral nursing programs should also be accredited. This issue, which has merits on both sides, has not yet been resolved.)

Recently NLN was dealt a blow when its deemed status as an accrediting agency for nursing education was threatened by the granting agency, the Department of Education (DOE). Part of NLN's effort to meet the objectives required by DOE in order to retain deemed status has involved creating the separate arm, the NLN Accrediting Commission (NLNAC).

Just as NLN offered JCAHO competition in home health accreditation, so the American Association of Colleges of Nursing (AACN) the organization of deans of baccalaureate and higher schools of nursing, has determined to offer NLN competition in the accreditation game. For decades, various members of AACN had proposed creating an accreditation service, and it was predictable that the group would take this period of NLN vulnerability as the time to propose its own accrediting process. AACN's present proposal for a "collaborative" accreditation process may end up threatening many or all of NLN's accrediting programs, not merely the baccalaureate and higher degree components. On the other hand, there is also talk about a cooperative venture between the two organizations, so time will tell what actually emerges. All these moves by the various organizations are typical of a health care environment like today's, that is, one run primarily by competition.

Issues in nursing education accreditation run the gamut from: "Do we really need it?" to "Does it have to take so much time and energy?" Ironically, it is often the more sophisticated programs (those most likely to pass with flying colors) that see the accreditation processes as redundant. For these programs, the process may be measured only by the lost opportunity costs of faculty and administrative time put into the extensive requirements of preparing a self-report. (AACN claims that shortening the process will be one of its chief aims.) On the other hand, some smaller or newer programs need the clout (or threat) of accreditation requirements to gain resources from the home institution.